Edie Shen, MD, FHM, Jenny Shen, MD, Susie Wlodarczyk, MD and Heather E. Nye, MD, PhD, SFHM, FACP

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Description

It is well established that older adults undergoing major surgery are at higher risk for complications and poor outcomes. This is related to a combination of decline in organ function, increased comorbidities, presence of geriatric syndromes, and reduced ability to compensate for stress. Despite overall worse outcomes, a higher proportion of people over 65 years of age are undergoing elective procedures as the population ages. It is imperative for hospitalists to be familiar with evidence-based approaches to assessment and optimization of the geriatric patient prior to surgery as well as best practices for care in the postoperative period. The American Geriatrics Society & American College of Surgeons have collaborated to create comprehensive perioperative practice standards for older adults that can be succinctly organized into a ‘Four M’ approach to ‘Age-Friendly’ care. This module reviews core principles of such care and outlines interventions shown to improve outcomes. 

Learning Objectives

After completing the activity, the participant will demonstrate the ability to:

1. Describe the impact of age and frailty on surgical outcomes
2. Assess cognitive status and delirium risk
3. Perform a frailty screen and discuss evidence-based risk reduction strategies for frail patients
4. Manage medications for older adults in the perioperative period
5. Delineate common postoperative complications in older adults and how to approach management
6. Elicit patient values and healthcare goals to inform shared decision-making around surgery
7. Summarize how interdisciplinary teams and care models improve outcomes for older adults undergoing surgery